GO

Evidence-Based Practice (EBP) Notes

Clinical Inquiry

  • Quality improvement (QI) – improve processes within a particular setting
  • Research – generate new knowledge
  • Evidence-based practice (EBP) – apply existing knowledge

EBP Components and Core Idea

  • EBP integrates four elements:
    • Best evidence
    • Clinical expertise
    • Patient values and preferences
    • Clinical setting

Evidence Sources

  • Pre-appraised evidence
    • Systematic reviews
    • Clinical practice guidelines
    • Evidence
  • Evidence from primary studies
  • Systematic reviews (as a type of evidence synthesis)

Evidence Hierarchy and Levels of Evidence

  • Systematic Review is associated with the highest level of evidence (Level I) and is described as the highest level in this scheme
  • Level I - Highest level of evidence
  • Level II - for therapy questions
    • Single randomized controlled trial (RCT)
  • Level II - for some etiology questions
    • Single non randomized trial (quasi-experiment)
    • Single prospective cohort study
    • Single case-control study
  • Level II - for prognosis questions
  • Level II - for some diagnosis questions
    • Single cross-sectional study (e.g., a survey)
  • Level II - for descriptive quantitative questions
    • Single in-depth qualitative study
  • Level II - for meaning and process questions
    • Expert opinion, case reports, etc.

Steps of the Evidence Based Practice (EBP) Process

1) Ask a clinically meaningful question
2) Collect the evidence
3) Critically appraise the evidence
4) Synthesize the evidence
5) Integrate evidence with clinical expertise, patient values and preferences, and clinical setting
6) Make a decision and implement
7) Evaluate outcomes

Models for EBP

  • ACE Star Model of Knowledge Transformation
  • Advancing Research and Clinical Practice through Close Collaboration (ARCC) Model
  • Iowa Model of EBP
  • Joanna Briggs Institute Model of Evidence Based Healthcare
  • Johns Hopkins Nursing Evidence-based Practice Model
  • Knowledge-to-Action Cycle
  • Promoting Action on Research Implementation in Health Sciences (PARIHS) Framework
  • Rosswurm and Larrabee Model to Change Clinical Practice
  • Stetler Organizational Framework for EBP